Comparison of Microtia reconstruction outcomes using rib cartilage vs porous polyethylene implant

Kristin K. Constantine, Jim Gilmore, Kenneth Lee, Joseph Leach

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

IMPORTANCE Auricular reconstruction is a unique blend of cosmesis and functionality. The choice of the optimal framework material to use is an important decision for the patient with microtia. OBJECTIVE To evaluate and compare the outcomes of reconstruction of microtia using porous polyethylene implants and rib cartilage grafts. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review from January 1, 2001, through December 31, 2012 at a tertiary academic institution. Thirty-five patients (36 ears) undergoing microtia repair were divided into groups using high-density porous polyethylene (17 ears), rib cartilage (17 ears), and both materials (2 ears). Only patients with completed repair were included in the analysis. EXPOSURES Reconstructive surgery for microtia. MAIN OUTCOME AND MEASURES We compared groups in terms of mean number of operations, age at treatment initiation, and complications (infection, extrusion, cartilage exposure, and pneumothorax). Photographs were graded by blinded observers to give each patient a score on protrusion, definition, shape, size, location, and color match. RESULTS The cartilage group was older than the polyethylene group (mean age, 8.0 vs 6.9 years; P = .23). The mean number of operations was 4.88 for the cartilage group vs 3.35 for the polyethylene group (P = .004). Two patients in the polyethylene group had postoperative infections and implant extrusion and underwent subsequent reconstruction with cartilage grafts. Patients in the cartilage group had no infection or extrusion; 1 had a minor cartilage exposure. No patient had pneumothorax. Patients in the polyethylene group had significantly better grades for ear definition and size match, whereas those in the cartilage group had a significantly better color match. Patients in the cartilage group had better protrusion and location outcomes, although the difference was not significant. CONCLUSIONS AND RELEVANCE Comparison of reconstruction with porous polyethylene implants and rib cartilage grafts showed neither material to be clearly superior. Polyethylene implants may achieve a better cosmetic outcome in the categories of ear definition, shape, and size with a higher risk for infection and extrusion. Patients in the cartilage group were older and underwent significantly more surgical procedures, which should factor into the decision on which technique to choose.

Original languageEnglish (US)
Pages (from-to)240-244
Number of pages5
JournalJAMA Facial Plastic Surgery
Volume16
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Polyethylene
Ribs
Cartilage
Ear
Pneumothorax
Infection
Transplants
Reconstructive Surgical Procedures
Congenital Microtia
Pyridinolcarbamate
Color
Ear Cartilage
Cosmetics
Medical Records
Age Groups

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Comparison of Microtia reconstruction outcomes using rib cartilage vs porous polyethylene implant. / Constantine, Kristin K.; Gilmore, Jim; Lee, Kenneth; Leach, Joseph.

In: JAMA Facial Plastic Surgery, Vol. 16, No. 4, 2014, p. 240-244.

Research output: Contribution to journalArticle

@article{fe5cb7aff9c048f899e3412fc38c3e47,
title = "Comparison of Microtia reconstruction outcomes using rib cartilage vs porous polyethylene implant",
abstract = "IMPORTANCE Auricular reconstruction is a unique blend of cosmesis and functionality. The choice of the optimal framework material to use is an important decision for the patient with microtia. OBJECTIVE To evaluate and compare the outcomes of reconstruction of microtia using porous polyethylene implants and rib cartilage grafts. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review from January 1, 2001, through December 31, 2012 at a tertiary academic institution. Thirty-five patients (36 ears) undergoing microtia repair were divided into groups using high-density porous polyethylene (17 ears), rib cartilage (17 ears), and both materials (2 ears). Only patients with completed repair were included in the analysis. EXPOSURES Reconstructive surgery for microtia. MAIN OUTCOME AND MEASURES We compared groups in terms of mean number of operations, age at treatment initiation, and complications (infection, extrusion, cartilage exposure, and pneumothorax). Photographs were graded by blinded observers to give each patient a score on protrusion, definition, shape, size, location, and color match. RESULTS The cartilage group was older than the polyethylene group (mean age, 8.0 vs 6.9 years; P = .23). The mean number of operations was 4.88 for the cartilage group vs 3.35 for the polyethylene group (P = .004). Two patients in the polyethylene group had postoperative infections and implant extrusion and underwent subsequent reconstruction with cartilage grafts. Patients in the cartilage group had no infection or extrusion; 1 had a minor cartilage exposure. No patient had pneumothorax. Patients in the polyethylene group had significantly better grades for ear definition and size match, whereas those in the cartilage group had a significantly better color match. Patients in the cartilage group had better protrusion and location outcomes, although the difference was not significant. CONCLUSIONS AND RELEVANCE Comparison of reconstruction with porous polyethylene implants and rib cartilage grafts showed neither material to be clearly superior. Polyethylene implants may achieve a better cosmetic outcome in the categories of ear definition, shape, and size with a higher risk for infection and extrusion. Patients in the cartilage group were older and underwent significantly more surgical procedures, which should factor into the decision on which technique to choose.",
author = "Constantine, {Kristin K.} and Jim Gilmore and Kenneth Lee and Joseph Leach",
year = "2014",
doi = "10.1001/jamafacial.2014.30",
language = "English (US)",
volume = "16",
pages = "240--244",
journal = "JAMA Facial Plastic Surgery",
issn = "2168-6076",
publisher = "American Medical Association",
number = "4",

}

TY - JOUR

T1 - Comparison of Microtia reconstruction outcomes using rib cartilage vs porous polyethylene implant

AU - Constantine, Kristin K.

AU - Gilmore, Jim

AU - Lee, Kenneth

AU - Leach, Joseph

PY - 2014

Y1 - 2014

N2 - IMPORTANCE Auricular reconstruction is a unique blend of cosmesis and functionality. The choice of the optimal framework material to use is an important decision for the patient with microtia. OBJECTIVE To evaluate and compare the outcomes of reconstruction of microtia using porous polyethylene implants and rib cartilage grafts. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review from January 1, 2001, through December 31, 2012 at a tertiary academic institution. Thirty-five patients (36 ears) undergoing microtia repair were divided into groups using high-density porous polyethylene (17 ears), rib cartilage (17 ears), and both materials (2 ears). Only patients with completed repair were included in the analysis. EXPOSURES Reconstructive surgery for microtia. MAIN OUTCOME AND MEASURES We compared groups in terms of mean number of operations, age at treatment initiation, and complications (infection, extrusion, cartilage exposure, and pneumothorax). Photographs were graded by blinded observers to give each patient a score on protrusion, definition, shape, size, location, and color match. RESULTS The cartilage group was older than the polyethylene group (mean age, 8.0 vs 6.9 years; P = .23). The mean number of operations was 4.88 for the cartilage group vs 3.35 for the polyethylene group (P = .004). Two patients in the polyethylene group had postoperative infections and implant extrusion and underwent subsequent reconstruction with cartilage grafts. Patients in the cartilage group had no infection or extrusion; 1 had a minor cartilage exposure. No patient had pneumothorax. Patients in the polyethylene group had significantly better grades for ear definition and size match, whereas those in the cartilage group had a significantly better color match. Patients in the cartilage group had better protrusion and location outcomes, although the difference was not significant. CONCLUSIONS AND RELEVANCE Comparison of reconstruction with porous polyethylene implants and rib cartilage grafts showed neither material to be clearly superior. Polyethylene implants may achieve a better cosmetic outcome in the categories of ear definition, shape, and size with a higher risk for infection and extrusion. Patients in the cartilage group were older and underwent significantly more surgical procedures, which should factor into the decision on which technique to choose.

AB - IMPORTANCE Auricular reconstruction is a unique blend of cosmesis and functionality. The choice of the optimal framework material to use is an important decision for the patient with microtia. OBJECTIVE To evaluate and compare the outcomes of reconstruction of microtia using porous polyethylene implants and rib cartilage grafts. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review from January 1, 2001, through December 31, 2012 at a tertiary academic institution. Thirty-five patients (36 ears) undergoing microtia repair were divided into groups using high-density porous polyethylene (17 ears), rib cartilage (17 ears), and both materials (2 ears). Only patients with completed repair were included in the analysis. EXPOSURES Reconstructive surgery for microtia. MAIN OUTCOME AND MEASURES We compared groups in terms of mean number of operations, age at treatment initiation, and complications (infection, extrusion, cartilage exposure, and pneumothorax). Photographs were graded by blinded observers to give each patient a score on protrusion, definition, shape, size, location, and color match. RESULTS The cartilage group was older than the polyethylene group (mean age, 8.0 vs 6.9 years; P = .23). The mean number of operations was 4.88 for the cartilage group vs 3.35 for the polyethylene group (P = .004). Two patients in the polyethylene group had postoperative infections and implant extrusion and underwent subsequent reconstruction with cartilage grafts. Patients in the cartilage group had no infection or extrusion; 1 had a minor cartilage exposure. No patient had pneumothorax. Patients in the polyethylene group had significantly better grades for ear definition and size match, whereas those in the cartilage group had a significantly better color match. Patients in the cartilage group had better protrusion and location outcomes, although the difference was not significant. CONCLUSIONS AND RELEVANCE Comparison of reconstruction with porous polyethylene implants and rib cartilage grafts showed neither material to be clearly superior. Polyethylene implants may achieve a better cosmetic outcome in the categories of ear definition, shape, and size with a higher risk for infection and extrusion. Patients in the cartilage group were older and underwent significantly more surgical procedures, which should factor into the decision on which technique to choose.

UR - http://www.scopus.com/inward/record.url?scp=84907303730&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84907303730&partnerID=8YFLogxK

U2 - 10.1001/jamafacial.2014.30

DO - 10.1001/jamafacial.2014.30

M3 - Article

C2 - 24763669

AN - SCOPUS:84907303730

VL - 16

SP - 240

EP - 244

JO - JAMA Facial Plastic Surgery

JF - JAMA Facial Plastic Surgery

SN - 2168-6076

IS - 4

ER -